DECLINING TREND OF HIV-AIDS EPIDEMIC IN THE WORLD

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1 INTERNATIONAL DECLINING JOURNAL TREND OF RISK OF HIV-AIDS MANAGEMENT EPIDEMIC IN THE WORLD/ 41 Vol. 5, No. 1, January-June 2015: DECLINING TREND OF HIV-AIDS EPIDEMIC IN THE WORLD B. S. KAMBLE Associate Professor and HOD, Deptt. of Economics, K. L. E. Society, G. I. Bagewadi Arts, Science, Commerce and P.G. College, Nipani , Karnataka State. INTRODUCTION HIV-AIDS is a global epidemic has spreading at faster rate since its inceptions. It is slowly infected person and adversely effects on the socio-economic life of the infected population through social stigma, reduction in household family income and GDP at national level. It is caused by sexual inter course between HIV-infected person to non-infected persons drug users, blood transfer from HIV infected person to general population. The global number of people living with HIV was 8Mn in 1990, it rose to 33Mn in It was become serious problem before health science between 2000 to Though the proper treatment for its control is not known its extent has been in declining trend due to the introduction of ART, opening of family counseling, hiv-aids awareness and prevention programmes, wide use of condom in recent years. The spread and magnitude is not same in the every corner of the world. Hence this paper is an attempt to describe the status of HIV-AIDS, its impact and prevention programmes and schemes. GLOBAL SCENARIO Year wise Number of People Living with HIV in the World The number of people living with HIV (PLHV) rose from 8 million in 1990 to million by the end of Graph 1 indicates that, up to 2007 it has been increases. But, overall growth of the epidemic has stabilized in recent years. The annual number of new HIV infections has steadily declined due to the significant increase in people receiving antiretroviral, the number of AIDS-related deaths has also declined. Since the beginning of the epidemic, nearly 30 million people have died from AIDS-related causes. Categarywise Number of HIV-AIDS in the World in 2009 Table 1. Shows the global HIV and AIDS epidemic by the end of The total number of people living with HIV-AIDS was 33.3 Mn. of this, adults and women s share seems to largest with 30.8Mn and 15.9Mn respectively by the end of Women accounted

2 42 / IJRM 5(1) 2015 Graph 1: Yearwise Number of People Living with HIV in the World for just over half of all adults living with HIV worldwide. The people living with HIV-AIDS were between 31.4 to 35.3.to the total range to Deaths due to AIDS was 1.8mn., some 2.6 million. Table 1 Categarywise Number of HIV-AIDS By the End of 2009 Particulars Estimate Range People living with HIV/AIDS 33.3 million million Adults living with HIV/AIDS 30.8 million million Women living with HIV/AIDS 15.9 million million Children living with HIV/AIDS 2.5 million million People newly infected with HIV 2.6 million million Adults newly infected with HIV 2.2 million million AIDS deaths 1.8 million million Orphans (0-17) due to AIDS 16.6 million million Total infected Number million million Source: Statistics of the global HIV and AIDS epidemic, published by UNAIDS in November 2010, with reference to the end of People became infected with HIV, around 30.8 million adults and 2.5 million children were living with HIV, the epidemic had left behind 16.6 million AIDS orphans, defined as those aged under 18 who have lost one or both parents to AIDS by the end of Most of these children are babies born to women with HIV, who acquire the virus during pregnancy, labour or delivery, or through breast milk. Drugs are available to minimise

3 DECLINING TREND OF HIV-AIDS EPIDEMIC IN THE WORLD/ 43 the dangers of mother-to-child HIV transmission, but these are still often not reaching the places where they are most needed. Around half of PLHV become infected before they turn 25 years, and AIDS is the second most common cause of death among year old. The number of deaths probably peaked around 2004, and due to the expansion of antiretroviral therapy, declined by 19 per cent between 2004 and Region wise and Risk Group wise Extent of HIV-AIDS by the End of 2009 The overwhelming majority of people with HIV live in low- and middle-income countries. Table 2 presents the regionwise and riskwise extent of HIV-AIDS by the end of Sub-Saharan Africa accounts for two-thirds of all infected people. South and South-East Asia has the second highest number of PLHV. Table 2 Region wise and Risk Group wise Extent of HIV-AIDS by the End of 2009 in the World Region Adults & Adults & Adult AIDS-related children living children newly prevalence* deaths inadults with HIV/AIDS infected & children Sub-Saharan Africa 22.5 million 1.8 Mn Mn North Africa & Middle East 460, South and South-East Asia 4.1 million East Asia 770, Oceania 57, Central & South America 1.4 million Caribbean 240, Eastern Europe & Central Asia 1.4 million North America 1.5 million Western & Central Europe 820, Global Total 33.3 million 2.6Mn Source: UNAID USA: Note: Adult prevalence* Proportion of adults aged who are living with HIV/AIDS. Adults are defined as men and women aged 15 or above. Sub-Saharan Africa Sub-Saharan Africa is by far the region most-affected by the AIDS epidemic. The region has just over 10% of the world s population, but is home to 68% of all PLHV. An estimated 1.8 million adults and children became infected with HIV during contributing to a total of 22.5 million people living with HIV in the region. An estimated 1.3 million people died from AIDS-related illnesses in Southern Africa accounts for around 40% of the global total of women living with HIV. As many as a fifth of men in West Africa had visited sex workers in 2007 which means that they can act as a potential bridge for HIV transmission to the rest of the population, either through their wives or other sexual partners. Male and transgender sex workers (MTSW) in the region often engage in sex work for financial reasons and are at high risk of HIV infection. Low condom use among MTSW in particularly worrisome because of the increased risk of

4 44 / IJRM 5(1) 2015 HIV transmission associated with anal sex. Male sex workers are also found to have low condom use rates with their female clients. Asia Until recently it was thought that India was home to around 5.7 million PLHA- more than any other country in the world. In July 2007 this estimate was revised to between 2 million and 3.1 million. Other countries with large numbers of PLHV include China (740,000), Thailand (530,000) and Viet Nam (280,000). According to the Commission on AIDS in Asia men who buy sex are the single-most powerful driving force in Asia s HIV epidemics. There are an estimated 10 million sex workers in Asia, and 75 million male clients. National adult prevalence is still under 1% in the majority of this region s countries. However some Asian countries are very large and national averages may obscure serious epidemics in some smaller provinces and states. Although national adult HIV prevalence in India, for example, is below 1%, some states have an estimated prevalence well above this level. The Caribbean Around 17,000 people were newly infected with HIV in the Caribbean during ,000 less than The number of new infections has been declining slightly, but the total number of PLHV in the region has remained relatively stable. By the end of ,000 people were living with HIV - an adult prevalence of 1.0%. AIDS epidemics of certain countries such as Haiti and Jamaica, where HIV prevalence among sex workers is 5.3 per cent and 4.9 per cent respectively. Also in Guyana, the HIV prevalence among sex workers is very high at 16.6 per cent. Eastern Europe and Central Asia The AIDS epidemic in Eastern Europe and Central Asia is rapidly expanding. Some 130,000 people were infected with HIV in 2009, bringing the total number of people living with the virus to around 1.4 million. In 2009 an estimated 76,000 people died from AIDS-related illness, four times the number in Worst affected countries are the Russian Federation and Ukraine, but HIV continues to spread in Belarus, Kazakhstan, Kyrgyzstan and Uzbekistan. It is now estimated that around 980,000 people are living with HIV in the Russian Federation. North Africa and the Middle East The notion that this region has been largely unaffected by the global epidemic is not supported by the latest estimates, which indicate that 75,000 people acquired HIV in 2009, bringing the total number of PLHV and AIDS in the Middle East and North Africa to an estimated 460,000. In 2009 an estimated 23,000 people died from AIDS-related illnesses, an increase from 8,300 in Central and South America An estimated 1.4 million people were living with HIV in Central and South America at the end of Although the number of PLHV continues to increase, the number of

5 DECLINING TREND OF HIV-AIDS EPIDEMIC IN THE WORLD/ 45 PLHV newly infected with HIV appears to be decreasing slightly. Around 92,000 people became newly infected with HIV in 2009, 7,000 less than Around 58,000 people died from AIDS-related illnesses in 2009 in the region. Adult HIV prevalence in most countries is below 1%. Find out more about HIV in the Americas. North America, Oceania and Western and Central Europe It is estimated that 2.3 million PLHV in North America and Western and Central Europe, an increase from 1.8 million in In these two regions, a total of 35,000 people died from AIDS-related illnesses in The number of PLHV in Oceania almost doubled from 28,000 in 2001 to 57,000 in In recent years there has been a significant increase in new infections among men who have sex with men in higher-income countries. In both North America and Western and Central Europe women account for less than a third of all PLHV. Latin America Information about the role of sex workers in Latin America s AIDS epidemic is sparse, and shows a varied picture. A study released in 2006, which analysed sex workers in nine South American countries over a thirteen-year period, concluded that consistently low HIV prevalence s were detected among female commercial sex workers in South America, particularly in the Andean region. However, HIV prevalence among sex workers is high in Honduras (10%), Guatemala (4%) and El Salvador (3%). High rates of injecting drug use are common among sex workers in Central America, particularly on major drug trafficking routes. This is a major issue where HIV prevalence is high among female sex workers who inject drugs (12% in the Mexican border cities of Tijuana and Ciudad Juarez) as there is a significant risk of HIV infection being passed to male clients of sex workers and then into the wider population. UK The discovery of AIDS in the UK in the early 1980s, there was a steady increase in the number of people diagnosed with HIV. From 1987 to 1990 the cumulative number of reported HIV diagnoses almost doubled, from 8,016 to 15,166. Between 1990 and 1997 there were between 2,000 and 2,700 HIV diagnoses reported annually. From 1999 there was a steep increase in the number of annual HIV diagnoses, peaking in 2005 at 7,982. There was a slight decline in subsequent years A major component of the rapid increase over the past 15 years has been heterosexually acquired infection. Up until 1998, the highest number of new HIV infections was acquired through sex between men. However, since 1999 heterosexually acquired HIV has overtaken as the largest exposure category. Heterosexual sex accounted for 42 per cent of HIV diagnoses in 2010 and sex between men accounted for 38.5 per cent, compared to 1995 when 31 per cent were a result of heterosexual sex and 58 per cent of new HIV diagnoses resulted from sex between men. Most of the new diagnoses among heterosexuals are in people who probably acquired HIV in other countries, particularly Africa. However, the number of infections probably acquired from heterosexual sex within the UK increased from 157 in 2000 to approximately 416 in 2010.

6 India 46 / IJRM 5(1) 2015 India has the world s third-largest population suffering from HIV/AIDS. However, the estimated number of HIV infections in India has declined drastically in recent years from 5.5 million in 2005 to below 2.5 million in These new figures are supported by the World Health Organization and UNAIDS. According to the United Nations 2011 Aids report, there has been a 50% decline in the number of new HIV infections in the last 10 years in India HIV estimates are derived on the basis of HIV prevalence observed from STD, ANC, IDU, MSM and FSW sites. As per the standard AIDS case definition, cumulative AIDS cases have been reported from states and union territories/uts to the National AIDS Control Organization. Epidemiological analysis of reported AIDS cases reveals that: AIDS is affecting mainly young people in the sexually active age group. The majority of the HIV infections 87.7% are in the age group of years. The predominate mode of transmission of infection in the AIDS patients is through heterosexual contact 85.7%, followed by Injecting drug use 2.2%, blood transmission and blood product infusion 2.6%, prenatal and as 6.8%. In the HIV sentimental, surveillance, 2003, males account for 73.5% of AIDS cases and females 26.5% The ratio between 3:1. The most predominant opportunistic infection among AIDS patients is tuberculosis indicating a potential future high spread of the HIV-TB co-infection. HIV Incidence The estimates of the HIV incidence revealed that the number of new annual HIV infections has declined by more than 50 per cent during the last decade. It is estimated that India had approximately 1.2 lakh new HIV infections in 2009, as against 2.7 lakh in Of this, six high prevalence states account for 39 per cent of the cases, while the states of Odisha, Bihar, West Bengal, Uttar Pradesh, Rajasthan, Madhya Pradesh and Gujarat account for 41 per cent of new infections. Adult HIV Prevalence The estimated adult HIV prevalence in India was 0.32 per cent (0.26% 0.41%) in 2008 and 0.31 per cent (0.25% 0.39%) in The adult prevalence is 0.26 per cent among women and 0.38 per cent among men in 2008, and 0.25 per cent among women and 0.36 per cent among men in Declining Trends of Adult HIV Prevalence The adult HIV prevalence at national level has continued its steady decline from estimated level of 0.41 per cent in 2000 through 0.36 per cent in 2006 to 0.31 per cent in Living with HIV/AIDS (PLHA) The total number of people living with HIV/AIDS in India is estimated at 23.9 lakh in 2009 which was lakh in 2000 and lakh in Its extent was more between 2001 to 2004 (25.18 lakh to lakh). Then onward it has begins to declined.

7 AIDS Related Deaths DECLINING TREND OF HIV-AIDS EPIDEMIC IN THE WORLD/ 47 About 1.72 lakh people died of AIDS related causes in 2009 in India against 1.90 lakh in 2004, 1.96 lakh in The number of deaths was increases up to Since then it declined because of wider access to ART. Measures Made to Decline HIV-AIDS HIV-AIDS steadily increasing since 1999-peaking in 2007 at 2,803 around the world. It is likely this trend is due to an increase in HIV testing. It has been declining for spreading various awareness and prevention programmes fighting against HIV-AIDS in the world. Some of them are: Condom Programme Thailand, government in the early 1990s implemented the famous 100% Condom Programme, is enforcing mandatory condom use in commercial sex establishments throughout Thailand, which helped to significantly reduce the spread of HIV. A similar program has also significantly reduced HIV prevalence Cambodia since it began in 2001 (from 44% in 1998 to 8% in 2003 among sex workers older than 20 years). Prevention Campaigns A handful of countries in the Caribbean region have established HIV prevention campaigns aimed at sex workers; in Haiti, for example, a NGO called FOSREF offer sex workers HIV testing and counseling services, treatment for sexually transmitted infections and vocational training. Antiretroviral Treatment-ART The introduction of combination antiretroviral treatment in the mid-1990s has resulted in a steep decline in the number of AIDS cases and deaths reported each year in the world. Antiretroviral therapy has had a significant impact on the number of deaths from AIDS; in Southern Africa alone the scale-up of treatment contributed to an 18% decline in AIDS-related deaths between 2004 and Wider access to ART has resulted in a decline of the number of people dying due to AIDS related causes. The trend of annual AIDS deaths is showing a steady decline since the roll out of free ART programme in India in PMTCT Programmes The scale-up of PMTCT programmes has also contributed to a decline in the number of new HIV infections and AIDS-related deaths among children. Women are particularly affected by HIV in sub-saharan Africa. In India, the target intervention program, link work program, awareness program, blood safety, capacity building program, rise in the number of ART, PPTC, CTPC and working of NACO at national level, SAPS at state level, District supportive system with NGO brought down the extent of HIV-AIDS.

8 CONCLUSION 48 / IJRM 5(1) 2015 HIV-AIDS is global epidemic. In the beginning, lesser extent was found due to the lack of testing methods. In latter period all most all countries of the world known the tests of HIV-AIDS resulting in estimating the faster rise in the number of people infected from it in the world. As every country learned its adverse effects on human resource, individual and national life costly dieses, social stigma they started to search anti HIV AIDS measures. Consequently, a good number of its awareness, prevention and controlling steps found in the world. As are result, since 2007 its extent has been declining trend in the world. Since, it is non-curable the continuous implementation of anti-hiv-aid programmes and schemes are needs from time to time. References Mann J. M. (1989), AIDS: A Worldwide Pandemic, in Current Topics in AIDS, Vol. 2, edited by Gottlieb M.S., Jeffries D.J., Mildvan D., Pinching, A.J., Quinn T.C., John Wiley & Sons. UNAID REPORT (2009), Statistics of the Global HIV and AIDS Epidemic, Published by UNAIDS in November 2010, with Reference to the End of Altman, L. K. (1982), New Homosexual Disorder Worries Health Officials, The New York Times, May 11. CDC (1982), Kaposi s Sarcoma (KS), Pneumocystis Carinii Pneumonia (PCP), and Other Opportunistic Infections (01), Cases Reported to CDC as of July 8 [PDF]. MMWR Weekly (1982), Opportunistic Infections and Kaposi s Sarcoma Among Haitians in the United States, July 9, 31 (26), 353-4, Goedert J. J., Neuland C.Y., Wallen W.C. (1982), Amyl Nitrite may alter T lymphocytes in Homosexual Men, The Lancet, 1, Shearer G. M., Hurtenbach U. (1982), Is Sperm Immunosuppressive in Homosexuals and Vasectomized Men? Immunology Today, 3, McKeown P. (1982), Gay Plague Baffling Medical Detectives, Philadelphia, Daily News, August 9. McKeown P. (1982), Gay Plague Baffling Medical Detectives, Philadelphia, Daily News, August 9. UNAIDS 2008 Report on the Global AIDS Epidemic, Govt. India. The WHO Strategy (2003), Treating 3 Million by 2005: Making it Happen. MMWR Weekly (1982), Current Trends Update on Acquired Immune Deficiency Syndrome (AIDS)- United States, September 24, 31(37), , Grmek, M. D. (1990), History of AIDS: Emergence and Origin of a Modern Pandemic, Princeton University. Masur H., Michelis M.A., Greene J.B., Onorato I., Stouwe R.A., Holzman R.S., Wormser G., Brettman L., Lange M., Murray H. W. and Cunnigham-Rundles S. (1981), An Outbreak of Community Acquired Pneumocystis carinii pneumonia: initial manifestation of cellular immune dysfunction (1981), The New England Journal of Medicine, Vol. 305, , December 10, Number 24. MMWR Weekly (1981), Kaposi s Sarcoma and Pneumocystis Pneumonia among Homosexual Men- New York City and California, July 4, 30 (4), NACO (2010), Annual Report published by Department of AIDS, Ministry of Health and Family Welfare, Govt. of India. website: